title: Cowden syndrome. Managing multiple skeletal metastases of different origin: a case report.
abstract: BACKGROUND
  Cowden Syndrome is a rare autosomal dominant multiple hamartomatous condition, characterised by both benign and malignant tumours affecting multiple systems.
  
  
  METHODS
  We present a 47-year-old female patient with thigh pain that was diagnosed with Cowden syndrome 20 years ago and developed multiple and different skeletal metastases which became resistant to radio-chemotherapy. A percutaneous plate fixation of the distal femur with an intralesional excision and cementoplasty of the metastasis was performed initially. This was combined with a cemented total hip arthroplasty using an Exeter long revision stem and a cementoplasty of the femoral canal for the proximal lesions.
  
  
  CONCLUSIONS
  A meticulous approach to her complex metastatic disease resulted in successful palliative prophylactic reconstructive surgery that improved her quality of life, allowing her independent pain free walking for 12 months.
authors.affiliation: Academic Orthopaedic Unit, Leeds General Infirmary, Leeds School of Medicine, Leeds, LS1 3EX, UK. etsiridis@doctors.org.uk.
authors.forename: Antonios
authors.initials: A
authors.lastname: Angoules
authors.forename: Evangelia Maria
authors.initials: EM
authors.lastname: Tsapakis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Polyzois
authors.forename: Zakareya
authors.initials: Z
authors.lastname: Gamie
authors.forename: James Julian
authors.initials: JJ
authors.lastname: Rankine
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Tsiridis